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Category Archives: Eyes

Having Plastic Surgery is a big decision, and it is common for families to want to weigh in on the topic. But what do you do if your family is against you having surgery? This is actually a scenario that I see a few times a year. Before I delve in to how I help patients through this type of situation, let’s talk first about the financial aspect. Cosmetic surgery can be expensive. If your family or spouse doesn’t support your decision because they don’t think you as a family can afford it, you need to approach this like you would any big budget decision. Finances affect the entire family, so this is definitely an area where you and your spouse need to be in agreement. But if you’re single, and you are responsible for your own finances, it really doesn’t matter what other people (e.g. your grown children, friends, you parents) think. Your finances are your decision.

With that out of the way, there are two other common objections that I see family and friends make.

They worry about your health and safety. Whether you are medically a good candidate for surgery is a decision that should be made by your surgeon, possibly with input from your primary care physician. I have had family members tell me that they don’t think their mother or father is medically healthy enough to have surgery, but when I review the patient’s medical history, there is actually nothing concerning that would increase the risks of surgery. The only thing you can do here is to reassure your family that your doctor thinks you are medically healthy enough to have surgery. Seeing your family doctor for additional input may put your family’s mind at east, as this information would be coming from a trusted and known source, rather than a doctor you’ve just met.

They don’t think you need surgery. This objection comes up quite frequently. And this isn’t really surprising, because it’s a value judgement. If something bothers you, that is all that is important. Now granted, people do sometimes obsess over an area of the body that actually needs minimal improvement. And this is where your surgeon’s judgement is important. If I think that I can make a visible improvement that will make a patient happier, then I recommend surgery. But if I think that no improvement is possible or that the patient won’t be happy regardless of the results, that is not a patient I offer surgery to.

To summarize, the financial aspect of surgery is a decision that should be made as a team if you are married or otherwise share finances with someone. But if finances are solely your decision, then the opinions of other family and friends don’t matter. The other aspects of the decision to have surgery are 1) whether you are medically healthy enough, and 2) whether you’ll be able to achieve the results you want. Those parts of the decision should be made in collaboration with your surgeon and your primary care physician.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

The connective tissue that spans between the cheekbone and lower eyelid, called the orbital septum, stretches out with age. This allows the fat which surrounds the eyeball and protects it to “pooch out”, causing bags under the eyes (see the image below).

Original photo from emedicine.com

The gold-standard way to fix this is, of course, a lower eyelid lift (blepharoplasty). A blepharoplasty removes a small amount of the fat causing the bags under the eyes, and removes the excess skin as well. But what if you’re not ready to commit to having surgery?

There isn’t a non-surgical way to actually fix bags under the eyes, but we can camoflauge them. Adding filler at the top of the cheekbone to make the cheeks fuller will smooth the transition between the lower eyelid and the cheek. The filler I like for this area is Radisse®. Radiesse® is composed of calcium hydroxylapatite, a mineral found in your bones. It is gradually broken down by the body over 9-12 months, so it gives fairly long-lasting results. The key with filler is to place it over the cheekbone, not the actual lower eyelid. Lower eyelid skin is very thin and delicate, so filler can look unnatural in this area. The picture below outlines ideal filler placement with the blue dots.

Do you have a question about lower eyelid rejuvenation or cheek filler? I would love to address your questions in the comments section!

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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The lower eyelids are a common problem area; bags and dark circles can make you appear chronically tired regardless of how much rest you’ve had. There are several different causes for both bags under the eyes and dark circles, and each has a different treatment.

“Bags” under the eyes stem from two causes: protruding fat and excess skin.

There is a thin layer of connective tissue that stretches from the cheekbone to the lower eyelid. Behind this connective tissue is fat which protects the eyeball. This connective tissue weakens and stretches as we age, allowing the fat to “pooch out”, resulting in bags under the eyes. The diagram below is a cross section of the eye. The big circle on top is the actual eyeball, or globe. The cheekbone is highlighted in orange, and the lower eyelid is highlighted in green (this is actually the tarsal plate, a firm supportive layer of the lower eyelid, but for our purposes calling it the lower eyelid is close enough). The blue line highlights this connective tissue layer, the orbital septum. You can see the fat behind it, highlighted in light yellow.

Original photo from emedicine.com

Skin stretches as we age, and the excess skin contributes to bags under the eyes as well. The solution for both excess skin and protruding fat is a lower eyelid lift, or blepharoplasty. The excess skin and a small amount of fat are removed, smoothing the contour of the lower eyelid.

Dark circles also have several potential causes:

The lower eyelid skin is very thin, so the capillaries and blood vessels show through, causing a purplish shadow. Sleeping with your head elevated on several pillows and using cold compresses can help constrict these capillaries and improve the appearance of dark circles.

In darker skinned individuals the dark circles may be caused by excess skin pigmentation over the lower eyelid. If this is the case, laser treatments may help even out the pigmentation.

Increasing the amount of collagen in lower eyelid skin may help alleviate dark circles as well. Topical treatments such as RetinA will help increase levels of collagen. And laser treatments such as Profractional or Fraxel can also increase the amount of collagen. Dark circles can be fairly resistant to treatment, however, so you still may find that a good undereye concealer gives you the best improvement.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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Patients, friends and family often ask me what is entailed in getting an eye lift (blepharoplasty). This procedure can make a dramatic difference in a person’s appearance, so I think the assumption is that it must be pretty invasive, or entail an extended recovery. Fortunately neither are true, and today I’m going to clear up these misconceptions.

courtesy of shutterstock.com

An eyelid lift (blepharoplasty) does sound scary- after all, the incision is right over your eye. But in terms of invasiveness and recovery time, eye lifts are on the very low end of the spectrum. In an upper eyelid lift, the procedure is essentially removing excess skin, and possibly some excess fat. So if you think about it, other than the location this is comparable to having a torn earlobe repaired or a mole removed. Lower eyelid lifts are a bit more involved: depending on the specific patient, a lower blepharoplasty may involve removal of skin, removal of some fat, and suspension of the lower eyelid to the outer corner of the orbit (the bones around the eye) to support a lax lower eyelid. Because of this, lower eyelid lifts are usually done with at least some sedation. Upper lifts, however, can be done in the office with local anesthesia.

What about the recovery? Eyelids area delicate area, so you can expect some bruising and swelling afterwards. Patients who have an upper lid lift are swollen for around a week, but they generally feel fine as soon as the next day. In terms of activity restrictions, expect your doctor to limit any heavy exercise for a couple of weeks to minimize the bleeding and swelling. But I have many patients return to work after only a couple of days off. If you have your lower eyelids done as well, expect a little more bruising and swelling, and you may have a dry-eye sensation as well for a few days. Other than that, the recovery is very similar.

Have you thought about having an eyelid lift? If so, what made you decide one way or another?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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We’ve all seen the commercials- Debbie Boone crooning in the background while patients testify how happy they are and how refreshed they look after undergoing this “innovative… approach to facial rejuvenation.” But neither the commercials nor the website describe what a “Lifestyle Lift” actually is.

The very short answer is that Lifestyle Lift is a company, not an actual surgical procedure. Close scrutiny of the website reveals that the company does not describe any sort of “Lifestyle Lift” per se, but rather offers options of several different procedures, including “Eye Firming”, “Facial Firming”, and “Neck Firming”. From speaking to both patients who have been treated at Lifestyle Lift, and personally observing procedures in their facility, my understanding is that these procedures are simply traditional face-lift, neck lift, and blepharoplasty (eye lift) procedures. They tout their treatments as “innovative”, and “less invasive” than traditional face-lift, but I have been unable to find any actual description of what each type of procedure is. So far as I can discern, the major difference between having treatment at a Lifestyle Lift facility and seeing a traditional plastic surgeon is where the surgery is performed. Lifestyle Lift performs all procedures in their facility, and all procedures are all done under local anesthesia. Because there is no sedation involved, these facilities are not subject to accreditation under the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF), the organization which oversees the safety of outpatient surgical facilities. The Lifestyle Lift facilities certainly have the option of seeking accreditation, and if you are considering any type of outpatient surgical procedure, I certainly recommend asking your doctor if the facility is accredited by AAAASF to ensure your safety. In addition, I also recommend confirming that your surgeon is board-certified. If you are considering any type of facial cosmetic surgery, look for a surgeon that is board-certified by either the American Board of Plastic Surgery, or the American Board of Facial Plastic Surgery.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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Today I’m going to talk about Latisse– I think most of us have seen the commercials with Claire Danes, where she develops the most amazing eyelashes, just by putting a drop of Latisse on each eye every night. And unlike most mascara adds, the Latisse before and after pics are not digitally altered, nor do the models have any eye makeup on. So here are some of the questions I’m commonly asked about Latisse:

courtesy of office.com

1. Does it work? To this, I can emphatically say YES! It does work as advertised. I have personally used Latisse for nearly two years, and my eyelashes are looong. When I have mascara on, they actually touch my eyebrows.

2. How long does it take to see results? Here is where you have to be patient- it really does take the 2-4 months advertised to see the results. And yes, it gets difficult remember to use a medication every night when you don’t see results for several weeks. Using Latisse more than once a day does not make your lashes grow longer or faster- it just wastes the medication.

3. Do you have to keep using it? Again, yes. If you stop using Latisse, your eyelashes will gradually return to the length and thickness they were prior to treatment.

4. Is it hard to get the medication on that little brush? Surprisingly, no. Water has high surface tension, which is what holds it in a drop. This surface tension also pulls that little drop right onto the brush. From there, you brush it onto your upper lash line just as if you were applying eyeliner. And if a little drips into your eye, remember; Latisse was originally developed as a medication for glaucoma, so it’s perfectly safe to get into your eye. But you should remove your contacts prior to use, as the medication can absorb into your contact lenses.

5. Does Latisse change your eye color? The most common side effect of Latisse is minor eye irritation and itching, which occurs in about 4% of people. But the eye color change is what I find people really worry about. So can it change your eye color? Yes. Does it? What happens most often is that you will see a slight darkening of the skin on your upper eyelid along the lash line. This skin pigmentation fades if you stop using Latisse. The eye coloration changes in the iris are far less common, and were largely reported in patients who used bimatoprost ophthalmic solution for glaucoma- these patients were applying drops of medication directly into the eye, which is not at all how Latisse is applied. The color changes that can occur in the iris are permanent, however. So even though having your eyes change color is extremely unlikely, if this is something you absolutely cannot deal with, don’t use Latisse.

Overall, Latisse is a great product, that works as advertised. It is a prescription medication, but many physicians carry in their offices, meaning you don’t have to make a separate trip to a pharmacy.

Do you have any questions about Latisse? Or any experiences of your own you’d like to share?

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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In a previous post I talked about how aging of the forehead and cheeks can make your eyes look older. Today I’m going to talk about the eyelids themselves, and how we can reverse the effects of aging.

courtesy of office.com

First, let’s talk about the upper eyelids. Young eyes have a smooth upper lid, with a well-defined crease and no excess skin. Older eyes have excess skin, and may have some bulging medially (meaning near the midline). This bulging is actually fat inside the orbit. The orbital septum is a layer of connective tissue that keeps the fat inside the orbital cavity from bulging out. As we age, this layer of connective tissue weakens, allowing the fat to bulge out. In addition, our skin stretches and droops as we age.

So how do we fix this? It’s actually a relatively simple procedure:

Take off the excess skin. The resulting scar is well-hidden in the crease of the upper eyelid.

Remove the bulging fat. Removing just a pinch or two of fat smooths the contour of the upper eyelid.

One common question I am asked- are upper eye lifts (blepharoplasty) covered by insurance? The answer, as always, is that it depends. For the procedure to be covered, the upper eyelid skin has to be drooping so much that it actually obstructs your vision. If you have so much excess skin that it’s difficult to see your eyelashes, it very well may be covered by your insurance. In order to find out for sure, you will need to see your opthalmologist for a visual fields exam, which is basically a test to determine if your excess eyelid skin is blocking your vision.

Now what about the lower eyelids? Lower eyelids age in a similar way to the upper eyelids. Excess skin develops, and the fat in the orbit begins to push on the orbital septum (the connective tissue holding it back), causing bulging and bags under the eyes. The major difference between the upper and lower eyelids is that the lower eyelid can also develop laxity, meaning it becomes slack.

Lifting the lower eyelids is similar to to lifting the upper eyelids with one major difference:

The excess skin is taken off

The bulging fat is removed

Here’s the difference– the lower eyelid is tightened. The canthal ligament, which is the tough connective tissue that supports the lower eyelid, is suspended higher into the outer corner of the bones that make up the orbit. Not every patient needs this, but it is commonly done to help provide support to the lower eyelid.

Do you have any experience with eyelifts you would like to share? Or any questions you would like to ask?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.